颏下皮瓣在口腔癌切除术后重建中的应用探讨

Application of submental flap in oral cavity reconstruction following resection of oral cancer

目的探讨颏下皮瓣在口腔癌切除术后重建中的应用价值。方法纳入常德市第一人民医院三年内21例口腔癌患者。所有患者均行手术切除和颏下皮瓣重建,除1例患者延迟用逆行皮瓣重建。术后13例患者口腔内软组织缺损和8例患者口腔复合缺陷,均采用皮瓣修复重建。结果 21例患者原发肿瘤部位包括口腔颊黏膜（7例）、舌（4例）、牙槽缘（3例）、口底（5例）及唇（2例）等。本研究在分离颏下皮瓣前先进行颈淋巴清扫术。2例患者皮瓣完全坏死,3例患者中皮瓣部分坏死。3~44个月随访期内,1例患者死于肿瘤转移,4例患者颈部复发。结论在保证进行颈部淋巴结清扫前提下,颏下皮瓣是口腔内软骨组织损伤和口腔缺陷复合修复重建的有效方法,尤其是在老年患者中。

【Objective】 To investigate the application value of submental flap in oral cavity reconstruction.【Methods】A total of 21 patients with oral cavity cancers over a three-year period were included. All the patients underwent surgical resection and immediate reconstruction with submental flap except one patient who had delayed reconstruction with reversed flap. The flaps were used for reconstruction of intraoral soft tissue defect in 13 patients and composite defects in 8 patients. 【Results】Of the 21 patients 12 were males and 9 were females with the age ranged from 32 to 83 years. The primary tumor sites included buccal mucosa（7 cases）, tongue（4 cases）, alveolar margin（3 cases）, floor of mouth（5 cases） and lip（2 cases）. Eventually in this study, the neck dissection was com-pleted first before flap harvest. Complete flap loss occurred in 2 cases whereas 3 patients had partial flap loss.During the follow-up of 3 to 44 months, one patient died from tumor metastasis, four patients developed neck recurrences.【Conclusions】The submental flap is a valid option for reconstruction of intraoral soft tissue as well as composite oral defects particularly in elderly patients. However, oncologically sound neck dissection should be assured.